By: Suanu Bakor

Editor's note: This is the second of a short series of posts by students in the CSHH course Human Health, Bioethics, and Disability Studies. Students in this course analyzed current events that were related to the fields of bioethics and disability studies. Some of those assignments were modified to be presented here over the next few weeks as Destination HealthEU posts.

Zika virus has recently burst onto the national stage as a dangerous agent because of how fast it can spread and the disturbing reports of its effects on developing fetuses. Zika virus is transmitted by the Aedes mosquito and has a short incubation period, and though the ensuing disease triggers mild fever, skin rashes, and conjunctivitis, it generally does not cause great harm to the person infected. According to the World Health Organization (WHO), there is no current treatment system for the disease besides the general advice of getting rest and drinking extensive fluids. One particular effect that has become a point of debate for the medical community is the notion that the virus can cause a condition called microcephaly, an abnormally small brain, in the children of pregnant women who contracted the virus at some point during their pregnancy.[1] It has led to some difficult and controversial decisions by the governments whose nations have been affected by the virus. With the Zika virus being considered a public health threat, how should they direct people on topics like avoiding the disease or family planning? The spread of the virus brings up a host of questions that governing bodies must consider when giving direction on how best to minimize the damage the virus can cause.

Zika is transmitted by mosquitoes (image credit to JJ Harrison).

There are recommendations for the prevention of the spread of the disease, which include stopping the breeding of the mosquitoes, utilizing insect repellents, and using mosquito nets. While there is no current vaccine for the virus, research is ongoing to expand knowledge on the virus and its effects on people.[2] These effects are not necessarily limited to the ill health effects that the virus is known to cause. There are also societal issues to contend with when governing bodies debate this issue. Take for example a European woman who was working in Brazil and contracted the virus. She was at 13 weeks of gestation in northeastern Brazil but returned to Europe where her physicians performed an ultrasound examination that revealed a small fetal head size and brain calcifications consistent with those observed with microcephaly. After approval by national and hospital ethics boards, the patient chose to terminate her pregnancy.[3] The case of this particular woman and her decision to terminate her pregnancy after finding out that her child had microcephaly sheds light on the complicated bioethical issues that continue to emerge. The national ethics board came to a decision based on bioethical principles and saw fit to allow the pregnancy termination, an action made on the basis of respecting the woman’s autonomy and seeing that justice is shown to her. Members of the disability community may have wanted to see more done for the woman to help her understand that even if her child was disabled, a disabled life is still worth living and caring for. For them, justice for the child was not fully considered.

While the woman does have autonomy to make a final decision, did her doctors and members of the ethics boards fully explain to her the circumstances surrounding her child, including the fact that her child could grow up without any developmental issues at all? Would it not be beneficent to let the child be born and then learn to handle and provide supports for any potential complications that may arise? Is it not maleficent to terminate a pregnancy simply because the mother did not want a potentially disabled child? How has justice been wrought in this situation given the fact that many women in the country of Brazil, from which she contracted the Zika virus, cannot access and will not be afforded the same care and treatment? Couldn’t this lead to many unsafe abortion practices because of the fear of delivering a child with microcephaly? These questions and many more must be considered and answered by the governing bodies within Brazil and in other nations affected by this virus.

The Zika virus has been labeled as an outbreak by the WHO and is currently at the forefront of maternal and neonatal public health agendas in Brazil and other countries that are currently affected or that could be affected because of upcoming mosquito seasons. These types of issues are not uncommon, and no matter what opinion one holds, it is apparent that such decisions are never made without much contemplation. Zika virus, its accompanying disease, and the effect on developing children has ignited a conversation for many who were not expecting to be faced with a decision like the one the European woman encountered. But this also allows for people to begin to understand and appreciate the different perspectives bioethics and disability studies have to offer on the issue.